State of Florida Department of Business and Professional Regulation Florida Real Estate Appraisal Board Application for Non-resident Temporary Practice Permit Form # DBPR FREAB 13 1 of 6 APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing. APPLICATION REQUIREMENTS ALL License Applicants must submit: Fees: $50. Make check or money order payable to the Florida Department of Business and Professional Regulation. Please mail your completed application, documentation and required fee(s) to: Department of Business and Professional Regulation 2601 Blair Stone Road Tallahassee, Fl 32399-0790 The State of Florida will recognize temporarily the certification of a real estate appraiser issued by another state and in good standing if the appraiser s business is of a temporary nature, the appraiser registers using this form before beginning the assignment, and pays the required fee. The temporary practice permit is only valid for a single appraisal assignment within Florida. A single appraisal assignment may include one or more properties under one contract for a single client. Assignment: As referenced herein, for purposes of temporary practice, means one or more real estate appraisals and written appraisal report(s) covered by a single contractual agreement. As defined by Section 475.611(p), Florida Statutes, a federally related transaction is any real estate related financial transaction, that a federal financial institution s regulatory agency or the Resolution Trust Corporation engages in, contracts for or regulates, which requires the services of a state licensed or state certified appraiser. Instructions If you have any questions or need assistance in completing this application, please contact the Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395. 1. Application Instructions (by section) a. Section I- Applicant Information i. Fill out each section completely. A Social Security number is required in order to apply for any individual license within the Department of Business and Professional Regulation. ii. In the Full Legal Name section provide your full legal name. Do not use any nicknames or initials. Please list any aliases or prior names in the prior name information section. iii. Provide your mailing address. This will be used for sending correspondence regarding your application and license. iv. Contact information is often used to quickly resolve questions with applications by telephone call or email. If contact information is not provided, questions regarding applications will be mailed to the applicant s mailing address and may take longer to resolve. v. Applicants are required to provide an out of state address. vi. Applicants must provide information on current or prior licenses held in Florida or any other state, territory, or jurisdiction of the United States or in any foreign national jurisdiction. vii. Applicants must provide information on any prior names or aliases used by applicant. If the name on supporting documentation does not match the applicant s legal name, the alias used in the supporting documentation must be provided in this section. Failure to do so will result in a deficient application.
2 of 6 b. Section II Federally Related Transaction i. Indicate which federal financial organization requires your appraisal services. If assignment is not for one of these federal financial organizations, you don t qualify for a temporary practice permit and will need to complete the application process for our state. ii. Indicate the type of licensure that you hold and provide the license/certification number along with the state of issuance. iii. Provide the client name, property description, project name and project address. iv. Provide client information as detailed in the engagement letter. v. List all of the properties in the engagement letter using the complete address of the subject properties, including suite numbers and/or apartment numbers. Use additional forms as needed to include all of the subject property or properties. c. Section III Affirmation by Written Declaration i. Please read and sign the affirmation by written declaration. ii. If the applicant fails to sign the affirmation statement, the application will be deficient and unable to be approved.
State of Florida Department of Business and Professional Regulation Florida Real Estate Appraisal Board Application for Non-Resident Temporary Practice Permit Form # DBPR FREAB 13 If you have any questions or need assistance in completing this application, please contact the Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395. For additional information see the Instructions at the beginning of this application. 3 of 6 Section I Applicant Information Social Security Number* APPLICANT INFORMATION FULL LEGAL NAME Birth Date (MM/DD/YYYY) or P.O. Box Gender Male Female MAILING ADDRESS Primary Phone Number CONTACT INFORMATION Primary E-Mail Address RESIDENCE ADDRESS (IF DIFFERENT THAN MAILING ADDRESS) Business Name BUSINESS LOCATION ADDRESS Phone Number BUSINESS CONTACT INFORMATION Fax Number E-Mail Address * The disclosure of your Social Security number is mandatory on all professional and occupational license applications, is solicited by the authority granted by 42 U.S.C. 653 and 654, and will be used by the Department of Business and Professional Regulation pursuant to 409.2577, 409.2598, 455.203(9), and 559.79(3), Florida Statutes, for the efficient screening of applicants and licensees by a Title IV-D child support agency to assure compliance with child support obligations. It is also required by 559.79(1), Florida Statutes, for determining eligibility for licensure and mandated by the authority granted by 42 U.S.C. 405(c)(2)(C)(i), to be used by the Department of Business and Professional Regulation to identify licensees for tax administration purposes.
Section I Applicant Information continued CURRENT/PRIOR LICENSE INFORMATION If you currently hold or have previously held a business or professional license/registration in Florida or (any state, province, district, territory, possession or nation jurisdiction of the United States or in any foreign national jurisdiction) elsewhere, please list each one below (attach additional copies of this page as necessary): 1. License/Registration Type State Date (From) License Number Name Used Date (To) 4 of 6 2. License/Registration Type State Date (From) License Number Name Used 3. License/Registration Type State Date (From) License Number Name Used Date (To) Date (To) PRIOR NAME INFORMATION Have you used, been known as, or are currently known by another name (e.g., maiden name or nickname) or alias other than the name signed to the application? Yes No If your answer is yes, state name or names used below: Section II Federally Related Transaction CLIENT NAME AND ADDRESS Please complete the below section as it appears in the engagement letter. An assignment as referenced herein, for purposes of temporary practice, means one or more real estate appraisals and written appraisal report(s) covered by a single contractual agreement. Client Name: Contact Name CLIENT CONTACT INFORMATION Phone Number
5 of 6 Section II Federally Related Transaction (cont.) FEDERALLY RELATED TRANSACTION INFORMATION Section 1121(5) Definitions [12 U.S.C. 3350] of Title XI of FIRREA defines the term real estate-related financial transaction as any transaction involving (A) the sale, lease, purchase, investment in or exchange of real property, including interests in property, or the financing thereof; (B) the refinancing of real property or interests in real property; and (C) the use of real property or interests in property as security for a loan or investment, including mortgage-backed securities. The transaction must be an assignment for one of the Federal Organizations listed below. If not, the request for temporary permit cannot be issued. Please check an organization: Federal Organization: Federal Deposit Insurance Corporation (FDIC) Board of Governors Federal Reserve System Office of the Comptroller of the Currency Department of Housing and Urban Development (HUD) Fannie Mae National Credit Union Administration Type of Licensure or Certification Held: Certified Residential Appraiser Freddie Mac Certified General Appraiser Licensed Appraiser Appraiser License/Certification Number State of Licensure/Certification Property Description Properties listed in the assignment (Use additional pages as needed) Project Name/Facility Name City State FL Zip Code (+4 optional) Property Description Project Name/ Facility Name City State FL Zip Code (+4 optional) Property Description Project Name Facility Name City State FL Zip Code (+4 optional)
Section III Affirmation By Written Declaration AFFIRMATION BY WRITTEN DECLARATION 6 of 6 I certify that I am empowered to execute this application as required by Section 559.79, Florida Statutes. I understand that my signature on this written declaration has the same legal effect as an oath or affirmation. Under penalties of perjury, I declare that I have read the foregoing application and the facts stated in it are true. I understand that falsification of any material information on this application may result in criminal penalty or administrative action, including a fine, suspension or revocation of the license. I further understand that I am competent and qualified to develop and communicate real estate appraisals with safety to the general public and those with whom the person may undertake a relationship of trust and confidence and that I pledge to comply with the Uniform Standards of Professional Appraisal Practice upon certification and understand the types of misconduct for which disciplinary proceedings may be initiated. Signature: Date: Print Name: